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Your gift will Light Up a Life! Your suggested contribution of $25 or more will benefit the Samaritan Evergree Hospice House Building Fund. A holiday letter will be sent acknowledging your gift. A special token can also be sent to that same person.

Donation Form

Light Up a Life - Albany General Hospital Foundation

Donation Amount (we suggest $25 per name honored):

1. This gift is:

In honor ofIn memory of

1. Name of person you wish to honor or remember:

1. Send acknowledgement of this gift to:

1. Acknowledgent name:

1. Address 1:

1. City/State/ZIP:

1. Please:

Send me the tokenSend the token to the individual receiving the acknowledgementDo not send the token

2. This gift is:

In honor ofIn memory of

2. Name of person you wish to honor or remember:

2. Send acknowledgement of this gift to:

2. Acknowledgent name:

2. Address 1:

2. City/State/ZIP:

2. Please:

Send me the tokenSend the token to the individual receiving the acknowledgementDo not send the token

3. This gift is:

In honor ofIn memory of

3. Name of person you wish to honor or remember:

3. Send acknowledgement of this gift to:

3. Acknowledgent name:

3. Address 1:

3. City/State/ZIP:

3. Please:

Send me the tokenSend the token to the individual receivingDo not send the token